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Previous issue date: 2009 === (...) O objetivo desta tese foi modelar os fatores de risco associados à ocorrência de leptospirose urbana em diferentes contextos, com especial atenção para aspectos espaciais e temporais. Foram utilizadas técnicas de modelagem tais como, modelos generalizados aditivos e mistos. Também explorou-se técnicas de detecção de aglomerados espaço-temporais. (...) === Leptospirosis, a disease caused by pathogenic spirochete of the genus Leptospira, is one of the most widespread zoonoses in the world, considered a major public health problem associated with the lack of sanitation and poverty. It is endemic in Brazil, data from surveillance show that outbreaks of leptospirosis occur as cyclical annual epidemics during rainfalls. The aim of this thesis was modeling the risk factors associated with the occurrence of leptospirosis in di erent urban contexts, with particular attention to spatial and temporal aspects. We used some modeling techniques such as generalized additive and mixed models. Techniques for detection space-time clusters were also explored. This thesis has prioritized the use of free softwares - R, ubuntu linux operating system, LATEX , SatScan (this is not open source but free). This thesis was prepared in the form of three articles. In the rst article is presented a spatio-temporal analysis of leptospirosis cases occurrence in Rio de Janeiro between 1997 and 2002. Using the detection of space-time clusters - \outbreaks" method - were statistically signi cant only cluster ocorred in 1997 and 1998. Generalized Linear Mixed Models were used to evaluate the risk factors associated with the occurrence of cases that belonged to outbreaks in endemic cases. The cases belonging to the outbreaks are associated with the occurrence of rainfall over 4 mm (OR, 3.71; 95% CI, 1.83 - 7.51). There were no signi cant associations with socioeconomic covariates, in other words, being
endemic or epidemic leptospirosis occurs in the same population. The second and third articles examined a seroprevalence survey and seroconversion cohort conducted in Pau da Lima community, Salvador, Bahia. In both Generalized Additive Models were used to t the exposure variables both in individuals and peridomicile context, as well as to estimate the spatial area of leptospirosis risk. The signi cant variables were: gender, age, presence of rats in the
peridomicile, domicile near a trash collectin or an open sewer and domicile altitude above sea level. Studies show that individual and contextual variables explain much of the spatial variability of leptospirosis, but there are still factors that were not measured in the studies but which should be investigated. The maps of risk of
seroprevalence and seroconversion show distinct regions where the spatial e ect is signi cantly di erent from the global average. It is still lack for a more robust integration between the professionals who develop and operate the GIS, epidemiologists and biostatistics. This integration represents an important advance enabling the development and use of these techniques in Public Health support. The study of prevalence and incidence of endemic areas, in the leptospirosis context, it is very complex and still grow up. The reunion of professional specialists from several areas of human knowledge (eg, clinicians, epidemiologists, geographers, biologists, statisticians, engineers, etc.), it is essential to advance the knowledge about the disease and their relationship to social inequality and environmental well to contribute to the creation of efficient and e ective measures to control endemic diseases.
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